Single lipoprotein apheresis session improves cardiac microvascular function in patients with elevated lipoprotein(a): detection by stress/rest perfusion magnetic resonance imaging.

The aim of this study was to explore the effects of a single lipoprotein apheresis session on myocardial stress/rest (S/R) perfusion in patients with elevated lipoprotein(a) (Lp(a)) and coronary artery disease using cardiac magnetic resonance imaging. Twenty patients with Lp(a) > 60 mg/dL and coronary artery disease were randomized into a control or a treatment group. Both groups underwent cardiac magnetic resonance imaging with assessment of left ventricular function, perfusion and viability, and the treatment group underwent lipoprotein apheresis immediately afterwards.

Acute oedema in the evaluation of microvascular reperfusion and myocardial salvage in reperfused myocardial infarction with cardiac magnetic resonance imaging.

Unlabelled: The accurate measurement of myocardial salvage is critical to the ongoing refinement of reperfusion strategies in acute myocardial infarction (AMI). Cardiac magnetic resonance imaging (CMR) can define the area at risk in AMI by the presence of myocardial oedema, identified by high signal intensity on T(2)-weighted imaging with a short inversion time inversion-recovery (STIR) sequence. In addition, myocardial necrosis can be identified with CMR delayed contrast enhanced imaging.

Cardiac magnetic resonance monitors reversible and irreversible myocardial injury in myocarditis.

Objectives: We sought to assess the value of cardiac magnetic resonance (CMR) to monitor the spectrum of myocarditis-related injuries over the course of the disease.

Background: Myocarditis is associated with a wide range of myocardial tissue injuries, both reversible and irreversible. Differentiating these types of injuries is a clinical demand.

Advanced methods for quantification of infarct size in mice using three-dimensional high-field late gadolinium enhancement MRI.

Conventional methods to quantify infarct size after myocardial infarction in mice are not ideal, requiring either tissue destruction for histology or relying on nondirect measurements such as wall motion. We therefore implemented a fast, high-resolution method to directly measure infarct size in vivo using three-dimensional (3D) late gadolinium enhancement MRI (3D-LGE). Myocardial T1 relaxation was quantified at 9.

Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling.

Objectives: We aimed to evaluate the incidence and patterns of late gadolinium enhancement (LGE) in different forms of left ventricular hypertrophy (LVH) and to determine their relation to severity of left ventricular (LV) remodeling.

Background: Left ventricular hypertrophy is an independent predictor of cardiac mortality. The relationship between LVH and myocardial fibrosis as defined by LGE cardiovascular magnetic resonance (CMR) is not well understood.

Cardiovascular magnetic resonance imaging detects cardiac involvement in Churg-Strauss syndrome.

Background: Cardiac involvement in Churg-Strauss vasculitis worsens the prognosis. Early detection is, therefore, warranted. Cardiac magnetic resonance (CMR) can visualize various forms of inflammatory changes in the myocardium.

Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: insights from cardiovascular magnetic resonance.

Background: Gender is an independent risk factor for heart failure mortality in hypertrophic cardiomyopathy (HCM).

Aims: To explore the interaction between gender, myocardial fibrosis and remodelling in HCM.

Methods: We studied 64 HCM patients (28 females, aged 51+/-16 years) categorized as non-obstructive (HNCM, n=31) or obstructive (HOCM, n=33) and 60 healthy subjects (31 females, aged 43+/-14 years).

Use of integrated biomarkers in inflammatory disease of the heart: new insights applying cardiovascular magnetic resonance potential as a biomarker.

Non-invasive myocardial tissue characterization of inflammatory heart disease is a challenging task. Cardiovascular magnetic resonance (CMR) has recently emerged as a powerful tool to fill this gap. In this article, the role of CMR is reviewed, particularly emphasizing the use of a comprehensive CMR approach to visualize several reversible and irreversible myocardial tissue changes in this setting.

Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach.

Systemic lupus erythematosus (SLE) is a multi-organ inflammatory disorder mainly affecting women and is associated with high cardiovascular morbidity and mortality. We tested the utility of a comprehensive cardiovascular magnetic resonance approach to assess myocardial involvement and to determine its relation to disease activity in SLE patients. We studied 20 SLE patients (19 females, 35+/-10 years) and 13 healthy volunteers (nine females, 28+/-11 years).

Single- or dual-bolus approach for the assessment of myocardial perfusion reserve in quantitative MR perfusion imaging.

A dual-bolus protocol can overcome limitations due to T1-induced MR signal attenuation and hence enables more accurate quantification of myocardial blood flow (MBF) by contrast enhanced MR perfusion imaging. The study explores potential benefits of the dual-bolus technique for the assessment of myocardial perfusion reserve (MPR) over a standard single-bolus protocol. Nineteen patients without obstructive coronary artery disease as assessed by cardiac catheterization underwent a stress-rest MR perfusion study using a dual-bolus protocol.

Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis--a CMR study.

Background: Myocardial edema is a substantial feature of the inflammatory response in human myocarditis. The relation between myocardial edema and myocardial mass in the course of healing myocarditis has not been systematically investigated. We hypothesised that the resolution of myocardial edema as visualised by T2-weighted cardiovascular magnetic resonance (CMR) is associated with a decrease of myocardial mass in steady state free precession (SSFP)-cine imaging.

The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance.

Objectives: We aimed to characterize the tissue changes within the perfusion bed of infarct-related vessels in patients with acutely reperfused myocardial infarction (MI) using cardiovascular magnetic resonance (CMR).

Background: Even in successful early revascularization, intermittent coronary artery occlusion affects the entire perfusion bed, also referred to as the area at risk. The extent of the salvaged area at risk contains prognostic information and may serve as a therapeutic target.

Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease.

Background: Late gadolinium-hyperenhancement (LHE) on cardiac magnetic resonance imaging (CMR) has been linked to cardiovascular risk in ischemic and non-ischemic heart disease. We aimed to systematically categorize LHE-patterns in a variety of non-ischemic heart diseases (NIHD) and to explore their relationship with left ventricular (LV) function.

Methods: In a retrospective database search, 156 patients with NIHD who exhibited LHE on CMR were identified.

Cardiovascular magnetic resonance T2-weighted imaging of myocardial edema in acute myocardial infarction.

Technical advances in cardiovascular magnetic resonance (CMR) T2-weighted imaging have allowed in-vivo visualization and accurate quantification of myocardial edema, a substantial feature of myocardial ischemic/reperfusion injury. In acute myocardial infarction, myocardial edema imaging can be used to differentiate acute from chronic irreversible injury. This can also be of particular importance in the sub-acute phase in which laboratory markers are equivocal or in the setting of missed infarction.

Assessment of late gadolinium enhancement in nonischemic cardiomyopathy: comparison of a fast Phase-Sensitive Inversion Recovery Sequence (PSIR) and a conventional segmented 2D gradient echo recall (GRE) sequence--preliminary findings.

Background: Reliable detection of myocardial scarring in nonischemic cardiomyopathy is time-consuming using techniques that require determination of optimal inversion time. Therefore we evaluated an inversion-time-insensitive approach using a fast phase-sensitive inversion recovery (PSIR) sequence to detect and quantify late gadolinium enhancement (LGE).

Patients And Methods: Twenty patients (mean age 40 years, 9 females) with nonischemic cardiomyopathy and evidence of LGE were evaluated.

Optimization and validation of a fully-integrated pulse sequence for modified look-locker inversion-recovery (MOLLI) T1 mapping of the heart.

Purpose: To optimize and validate a fully-integrated version of modified Look-Locker inversion-recovery (MOLLI) for clinical single-breathhold cardiac T1 mapping.

Materials And Methods: A MOLLI variant allowing direct access to all pulse sequence parameters was implemented on a 1.5T MR system.

Integrated biomarkers in cardiomyopathies: cardiovascular magnetic resonance imaging combined with molecular and immunologic markers--a stepwise approach for diagnosis and treatment.

In an integrated approach, the authors examine the most efficient combination of noninvasive and invasive biochemical, immunologic, functional, molecular, imaging and biopsy-derived biomarkers for their applicability in the diagnosis of cardiomyopathies in general and dilated cardiomyopathy (DCM) in particular. A careful selection out of the cascade of available biomarkers will allow, in individual patients, to diagnose certain conditions of cardiomyopathies without endomyocardial biopsy, e.g.

Contrast-dose relation in first-pass myocardial MR perfusion imaging.

Purpose: To determine the regime of linear contrast enhancement in human first-pass perfusion cardiovascular magnetic resonance (CMR) imaging to improve accuracy in myocardial perfusion quantification.

Materials And Methods: A total of 10 healthy subjects were studied on a clinical 1.5T MR scanner.

Biochemical and bioimaging markers for risk assessment and diagnosis in major cardiovascular diseases: a road to integration of complementary diagnostic tools.

This report from the first International Course on Integrated Biomarkers, Biochemical and Bioimaging Endpoints in Cardiovascular Diagnosis, Prevention, Therapy and Drug Development provides the basis for optimizing diagnostic, prognostic and therapeutic information in four areas of cardiovascular medicine: primary prevention of cardiovascular diseases, acute coronary syndromes, heart failure and stroke. Risk stratification and treatment strategies can be refined and enhanced through integration of bioimaging and biochemical markers to characterize sub-clinical and clinical atherosclerosis. For the integrative approach to be useful, each of the biomarkers must be validated and cost-effective.

Cardiac magnetic resonance and cardiac magnetic field mapping in a patient with stress-induced cardiomyopathy (tako-tsubo).

We encountered a 65-year-old woman with typical electrocardiogram (ECG) changes and new-onset left ventricular dysfunction with apical ballooning that exhibited typical changes of tako-tsubo-like cardiomyopathy. We used cardiac magnetic resonance (CMR) and cardiac magnetic field mapping (CMFM) to detect changes in structural, mechanical, and electrophysiological myocardial properties during follow-up. CMR displayed an acute myocardial injury, but neither fibrosis nor necrosis.

Contrast-enhanced cardiovascular magnetic resonance imaging of right ventricular infarction.

Objectives: We assessed the role of late enhancement cardiovascular magnetic resonance imaging (LE-CMR) for the diagnosis of right ventricular infarction (RVI).

Background: Right ventricular infarction occurs in about one-half of patients with inferior myocardial infarction (MI). It is associated with an unfavorable prognosis, but established methods often lack the diagnostic accuracy to detect it.

Left ventricular outflow tract planimetry by cardiovascular magnetic resonance differentiates obstructive from non-obstructive hypertrophic cardiomyopathy.

The relation to the pressure gradient as assessed by echocardiography and the CMR-derived planimetry of the LVOT is not known, no values for the differentiation of obstruction exist. We studied 37 patients with hypertrophic cardiomyopathy and 14 healthy controls using standard sequences with 3D coverage of the left ventricular outflow tract. A cutoff value of 2.

Elective percutaneous coronary intervention immediately impairs resting microvascular perfusion assessed by cardiac magnetic resonance imaging.

Background: Percutaneous coronary intervention (PCI) is known to induce atherosclerotic plaque rupture, which may affect resting distal microvascular perfusion either through distal microvascular spasm or through embolization. We evaluated the effect of PCI on resting microvascular flow.

Methods: We performed cardiovascular magnetic resonance imaging to assess left ventricular systolic function and microvascular perfusion in 15 patients with stable coronary artery disease before and within 24 hours after PCI and in 10 control subjects without obstructive coronary artery disease on a clinical 1.